Sarpagandha Powder by Vedic Care

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Abdominal pain. Although there has been interest in using oral Indian snakeroot for abdominal pain, there is insufficient reliable information about the clinical effects of Indian snakeroot for this purpose.
• Anxiety. It is unclear if oral Indian snakeroot is beneficial in patients with anxiety. Details: A single, small, low-quality clinical study shows that taking Indian snakeroot crude root 300-2000 mg orally daily, or an Indian snakeroot extract (alseroxylon, Rauwiloid) 4-64 mg orally daily, for an average of 20 days reduces symptoms of anxiety when compared with baseline in patients with various psychiatric disorders, including schizophrenia, personality disorders, and psychoneurotic disorders. A moderate decrease in anxiety or complete remission occurred in 80% of patients taking the crude root, 78% of those taking the extract, and 79% of patients taking the constituent reserpine 0.75-14 mg (94330). The validity of this study is limited by the lack of a comparator group.
• Constipation. Although there has been interest in using oral Indian snakeroot for constipation, there is insufficient reliable information about the clinical effects of Indian snakeroot for this purpose.
• Epilepsy. Although there has been interest in using oral Indian snakeroot for epilepsy, there is insufficient reliable information about the clinical effects of Indian snakeroot for this purpose.
• Hypertension. It is unclear if oral Indian snakeroot is beneficial in patients with hypertension. Details: Preliminary, low-quality, clinical research in adults with hypertension shows that taking Indian snakeroot 200-400 mg orally daily for up to 3 months reduces systolic and diastolic blood pressure by averages of 21-27 mmHg and 11-14 mmHg, respectively, when compared with baseline (94332,94438,94331,94440). Some evidence suggests that taking crude Indian snakeroot 400 mg daily may be as effective as taking isolated reserpine 0.4 mg daily (94438). Some clinical trials have also studied a specific Indian snakeroot product (Serpina, Himalaya Drug Company) as 1-4 tablets daily for up to one year. However, the tablet strength was not reported (94331,94438).
• Insect bite. Although there has been interest in using oral Indian snakeroot for insect bites, there is insufficient reliable information about the clinical effects of Indian snakeroot for this purpose.
• Insomnia. Oral Indian snakeroot has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with chronic insomnia shows that taking Indian snakeroot root extract 200 mg orally in a specific combination with valerian rhizome 200 mg and Tinospora cordifolia extract 200 mg for 21 days reduces sleep latency by 11 minutes and increases total sleep by 58 minutes when compared with the placebo run-in period (6051). It is unclear if this effect is due to Indian snakeroot, other ingredients, or the combination.
• Malaria. Although there has been interest in using oral Indian snakeroot for malaria, there is insufficient reliable information about the clinical effects of Indian snakeroot for this purpose.
• Psychosis. Although there has been interest in using oral Indian snakeroot for psychosis, there is insufficient reliable information about the clinical effects of Indian snakeroot for this purpose.
• Rheumatoid arthritis (RA). Although there has been interest in using oral Indian snakeroot for RA, there is insufficient reliable information about the clinical effects of Indian snakeroot for this purpose.
• Schizophrenia. Although there has been interest in using oral Indian snakeroot for schizophrenia, there is insufficient reliable information about the clinical effects of Indian snakeroot for this purpose. More evidence is needed to rate Indian snakeroot for these uses.

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POSSIBLY UNSAFE ...when used orally. Indian snakeroot contains small amounts of the drugs reserpine and yohimbine. Although most adverse effects to Indian snakeroot appear to be mild, higher doses can cause cardiovascular side effects including bradycardia and hypotension. Prolonged use can cause depression in some people (94330,94331,94332,94438,94440).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using. The reserpine alkaloid constituents appear to cross the placenta and are excreted in breast milk (4260).

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ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking Indian snakeroot might increase the risk of bleeding when used with antiplatelet or anticoagulant drugs.  Details Indian snakeroot contains small amounts of the drug yohimbine. In vitro research shows that yohimbine inhibits platelet aggregation (86773,86806,86835,86853).

ANTIDIABETES DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of Indian snakeroot with antidiabetes drugs might increase the risk of hypoglycemia.  Details Animal research shows that Indian snakeroot lowers blood glucose levels (94344,94353). This effect has not been reported in humans.

ANTIHYPERTENSIVE DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B Theoretically, concomitant use of Indian snakeroot and antihypertensive drugs might increase the risk of hypotension.  Details Indian snakeroot, which contains reserpine, can reduce both systolic and diastolic blood pressure (94328,94331,94332).

ANTIPSYCHOTIC DRUGS Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, concomitant use might increase the risk of adverse effects.  Details Concomitant use of neuroleptics with Indian snakeroot may potentiate the effects of these drugs, as well as the alkaloid constituents of Indian snakeroot (2,18).

BETA-BLOCKERS Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking Indian snakeroot with beta-blockers might increase the risk of bradycardia and/or hypotension.  Details Indian snakeroot contains small amounts of reserpine. Reserpine causes catecholamine-depletion (15). Concomitant use of Indian snakeroot and beta-blockers might increase the risk or bradycardia and/or hypotension.

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking Indian snakeroot might cause additive sedative effects.  Details Sedation and drowsiness have been reported in clinical trials using Indian snakeroot (94331,94332,94438,94440).

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, Indian snakeroot might inhibit CYP2D6 enzymes and reduce the metabolism of CYP2D6 substrates.  Details Indian snakeroot contains small amounts of the drug yohimbine. In vitro research shows that yohimbine inhibits CYP2D6 enzyme activity (23117).

DIGOXIN (Lanoxin) Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking Indian snakeroot with digoxin might increase the risk of bradycardia.  Details Bradycardia has been reported in clinical trials using Indian snakeroot (94331,94440). Concomitant use of digoxin with Indian snakeroot might potentiate this effect.

EPHEDRINE Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking Indian snakeroot with ephedrine might alter the effects and side effects of ephedrine.  Details Indian snakeroot contains small amounts of reserpine. Reserpine reduces indirect sympathomimetic drug activity. However, another constituent of Indian snakeroot, yohimbine, has stimulant activity and may increase the risk of adverse effects with ephedrine (15,18).

LEVODOPA Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Probable •  Level of Evidence = D Theoretically, taking Indian snakeroot with levodopa may reduce the effectiveness of levodopa.  Details Extrapyramidal motor symptoms and Parkinson-like symptoms have been reported in clinical trials using Indian snakeroot (94328,94332). Concomitant use of Indian snakeroot with levodopa may reduce the effectiveness of levodopa and increase extrapyramidal motor symptoms (15,18).

MONOAMINE OXIDASE INHIBITORS (MAOIs) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, taking Indian snakeroot with MAOIs might cause additive effects.  Details Yohimbine, a constituent of Indian snakeroot, has MAO inhibitory effects. At high doses, yohimbine is a non-selective inhibitor of MAO (11,12).

STIMULANT DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use might cause additive effects.  Details Yohimbine, a constituent of Indian snakeroot, has sympathomimetic effects and increases blood pressure in a dose-dependent manner. Theoretically, taking Indian snakeroot with stimulant drugs can have additive stimulant and hypertensive effects (11,12,105698).

TRICYCLIC ANTIDEPRESSANTS (TCAs) Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use might alter the effects of Indian snakeroot and increase the risk of adverse effects.  Details A small clinical study in patients taking TCAs for at least 4 weeks shows that receiving doses of intravenous yohimbine, a constituent of Indian snakeroot, 2.5-20 mg daily for up to 7 days precipitates severe anxiety, agitation, and tremor (105881). Also, concomitant use of TCAs with Indian snakeroot may decrease the effects of other rauwolfia alkaloids (15).

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General ...Orally, Indian snakeroot may be unsafe, particularly at high doses. Most adverse effects are thought to be from the constituents reserpine and yohimbine.
Most Common Adverse Effects:
Orally: Abdominal pain, bradycardia, congestion, diarrhea, hypotension, increased appetite, nightmares, sedation, weight gain.
Serious Adverse Effects (Rare):
Orally: Atrial fibrillation, convulsions, depression, myocardial infarction.

Cardiovascular ...Orally, Indian snakeroot has been associated with reports of bradycardia and mild hypotension. These adverse effects are thought to be related to the constituent reserpine (94331,94440). Adverse reactions to reserpine also include angina-like symptoms (94328). At high doses, adverse effects related to yohimbine, another constituent of Indian snakeroot, include hypertension, tachycardia, palpitations, myocardial infarction, and atrial fibrillation (3312,17465,86801,91521). A supplement containing Indian snakeroot and several other ingredients (Carditone, Ayush Herbs) has been associated with reduction in blood pressure and increase in serum potassium levels (102838).

Dermatologic ...Indian snakeroot contains small amounts of reserpine and yohimbine and may theoretically cause some of the adverse effects associated with these constituents. Orally, reserpine can cause facial flushing, skin rash, and itching (94328). Yohimbine may cause rash, erythrodermic skin eruption, and exanthema (3312,3971,86878,86896).

Endocrine ...Indian snakeroot contains small amounts of reserpine and may theoretically cause some of the adverse effects associated with this constituent. Orally, reserpine can cause galactorrhea and breast enlargement (275,94328).

Gastrointestinal ...Orally, Indian snakeroot has been associated with increased or decreased appetite, diarrhea, nausea, vomiting, and abdominal pain (94332,94438,94440). Yohimbine, a constituent of Indian snakeroot, has been associated with nausea, vomiting, increased salivation, diarrhea, and gastrointestinal distress (3970,17465,86780,86786,86804,86827,86896). Reserpine, another constituent of Indian snakeroot, may cause gastrointestinal irritation and activation of peptic ulcers (15,19).

Genitourinary ...Indian snakeroot contains small amounts of yohimbine and may theoretically cause some of the adverse effects associated with this constituent. Yohimbine may cause dartos contraction or decreased libido in some patients (86786,86882).

Hematologic ...Indian snakeroot contains small amounts of reserpine and yohimbine and may theoretically cause some of the adverse effects associated with these constituents. A case of drug-induced agranulocytosis has been reported following prolonged use of oral yohimbine (86877). Reserpine may cause thrombocytopenia (275).

Immunologic ...There is one report of a hypersensitivity reaction to yohimbine, a constituent of Indian snakeroot. Symptoms included fever, chills, malaise, itchy, scaly skin, progressive kidney failure, and a lupus-like syndrome (6169).

Musculoskeletal ...Orally, Indian snakeroot has been associated with muscle aches and cramps (94438).

Neurologic/CNS ...Orally, Indian snakeroot may cause headaches, feeling cold, dizziness, drowsiness, nightmares, and mild sedation (94331,94332,94438,94440). Indian snakeroot contains small amounts of reserpine and yohimbine and may theoretically cause some of the adverse effects associated with these constituents. Doses of reserpine of greater than 0.5 mg daily can increase the risk of side effects. In extremely large amounts, Parkinson-like symptoms, extrapyramidal reactions, and convulsions may occur (15,94328,94332). Orally, yohimbine has been associated with reports of tremulousness, head twitching, seizures, loss of consciousness, decreased energy, dizziness, vertigo, headache, feeling cold, flushing, diaphoresis, and paralysis (11,18,3312,3971,17465,86786,86801,86804,86827,86896).

Oncologic ...Indian snakeroot contains small amounts of reserpine and may theoretically cause some of the adverse effects associated with this constituent. Some preliminary research suggests a link between reserpine and an increased risk of breast cancer; but this has not been confirmed in further research (94328).

Psychiatric ...Orally, Indian snakeroot can cause emotional upset or depression, especially in people with prior episodes. This appears to be related to the constituent reserpine (94332,94438). One study shows the rate of depressive episodes is similar for patients taking Indian snakeroot and those taking reserpine (94438). Some research suggests that the risk of depression might increase with dose or the length of use. When taken for less than 40 days, depression did not occur in patients taking Indian snakeroot or reserpine (94330).
Indian snakeroot contains small amounts of yohimbine and may theoretically cause some of the adverse effects associated with this constituent. Orally, yohimbine may increase anxiety and impulsivity (17465,86784,86810).

Pulmonary/Respiratory ...Orally, Indian snakeroot can cause nasal stuffiness or congestion and shortness of breath (94330,94332,94438,94440). One study shows that Indian snakeroot may increase the risk for nasal congestion more than the constituent reserpine. (94438). Reserpine is also associated with rare reports of allergic reactions that can precipitate asthma (15,94328). Another constituent of Indian snakeroot, yohimbine, may cause bronchospasm, tachypnea, cough, sinusitis, and rhinorrhea (17465,86825,86850,94112). Excessive doses of yohimbine can cause respiratory depression (1118).

Renal ...Orally, Indian snakeroot may cause increased urination (94332).
Indian snakeroot contains small amounts of yohimbine and may theoretically cause some of the adverse effects associated with this constituent. A case of acute kidney failure related to yohimbine-induced systemic lupus erythematosus has been reported (6169).

Other ...Orally, Indian snakeroot has been associated with reports of weight gain (94438).

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